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Published on: August 27, 2019
Mammalian Target of Rapamycin Inhibitor Monotherapy: Efficacy in Renal Transplantation
A Franco1, P Más-Serrano2, J Perez Contreras1
1Department of Nephrology, Hospital General Universitario de Alicante, Alicante, Spain.
Background:
Calcineurin inhibitors (CNI) have failed to improve long-term outcomes in renal transplantation. Anti-proliferative and anti-angiogenic effects of mammalian target of rapamycin inhibitors (m-TOR) without nephrotoxicity could improve long-term survival in selected transplant recipients.
Methods:
We examined the evolution of 98 low-immunological risk renal transplant recipients on m-TOR monotherapy: 7 patients had induction without CNI and 91 were switched to m-TOR at 12 (p25-p75: 4-36) months after transplant.
Results:
Median follow-up time was 46 (p25-p75: 28.5-72.0) months. Fifteen recipients dropped out of the study (15.3%): 8 patients (8.2%) had to change their immunosuppressive treatment because of complications and 7 (7.1%) lost their grafts as a result of chronic rejection (4 cases) or death with a functioning graft (3 cases). At the end of follow-up, 83 of 98 (84.6%) recipients remained on monotherapy. The rates of recipient and graft survivals were 100% and 98.8% at 2 years and 96.9% and 93.5% at 4 years; the percentages of patients on monotherapy after 2 and 4 years were 95.2% and 85.2%, respectively. Renal function improved significantly and proteinuria decreased but not significantly. Those patients switched to m-TOR significantly received more erythropoietin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and hypotensive agents than before starting m-TOR, whereas there were no significant changes related to the use of statins, body weight, or percentage of diabetic patients. No case of non-compliance was reported.
Conclusions:
This study supports the safety and efficacy of monotherapy with m-TOR in selected renal transplant recipients.
Insights
Mammalian target of rapamycin (m-TOR) inhibitors show promise as monotherapy in renal transplantation, improving outcomes without nephrotoxicity. This approach offers a safer, effective alternative for selected transplant recipients, enhancing long-term survival.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation Biology
Background:
- Calcineurin inhibitors (CNI) have limitations in improving long-term renal transplant outcomes.
- Mammalian target of rapamycin (m-TOR) inhibitors offer potential benefits due to anti-proliferative and anti-angiogenic effects without nephrotoxicity.
Purpose of the Study:
- To evaluate the safety and efficacy of mammalian target of rapamycin (m-TOR) inhibitor monotherapy in low-immunological risk renal transplant recipients.
- To assess long-term graft and patient survival rates, renal function, and adherence in patients on m-TOR monotherapy.
Main Methods:
- Retrospective analysis of 98 low-immunological risk renal transplant recipients.
- Patients received m-TOR monotherapy either as induction (7 patients) or switched from other immunosuppressants (91 patients) around 12 months post-transplant.
Main Results:
- High rates of patient (96.9%) and graft (93.5%) survival at 4 years were observed.
- 84.6% of recipients remained on m-TOR monotherapy at the end of follow-up (median 46 months).
- Significant improvement in renal function and no reported cases of non-compliance.
Conclusions:
- Monotherapy with mammalian target of rapamycin (m-TOR) inhibitors is safe and effective in selected renal transplant recipients.
- This strategy supports long-term graft survival and good renal function, offering an alternative to traditional immunosuppression.
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